The Pan(ic)demic trolley problem

“Eleven is more than three” was the title of a radio drama that made a strong impression on me when I listened to it in my early teens. The set was a coal mine fire where the person responsible had to make a choice about the direction of the fire. In one shaft there were three people, in the other there were 11. He made the rational choice. Except, one of the three was the husband of the woman he was having an affair with. His life was destroyed for making the right choice of saving eleven lives.

Policy making in the corona virus pan(ic)demic is the perfect example of the trolley problem. Except, of course, the clarity of the problem. And the political considerations. And the hysteria and blame machine of the media.

We have no idea (really) what’s going on. We only have theories. Of where it came from, of how contagious it is, of how exactly it is transmitted. Many of the theories may prove to be right, but we do not know yet for certain.

We don’t know how many people are infected. We just don’t do enough tests. In most places, only the sick, or those displaying symptoms are tested, while we know from limited experiments, such as the Diamond Princess case, that the infection rate is low, and half of the infected show no symptoms. We are calculating the morbidity rates without having the faintest clue about the true numbers of the infected.

We have graphs, models, projections and we are bombarded with ‘information’ which is, actually, meaningless. The models and their projections are based on unverified assumptions.
We will only know how serious this pandemic was once it is over and maybe not even then.

As an increasing number of experts point out, our only true protection is herd immunity, which can only be measured by large sample serology tests. Immunity can only be achieved by either developing the antibodies on our own, or through vaccination.

The numbers are bad on more ways than one. In the Czech Republic, the first person who died of the Covid-19 infection was a 95-year-old man. The second was in his fifties, but he also had stage four metastatic terminal cancer. What killed him? The cancer or the virus? We do not know how many would have died of their pre-existing conditions. If I test positive for the virus then get hit by a car on my way home, will I show up in the statistics as a victim of the virus? I believe I would.

The projections in the media are even worse. Look at this intellectual juggling from the NBC New York web site:

“New York had 4,749 deaths as a result of influenza and pneumonia in 2018, according to the Centers for Disease Control […] If divided equally over the course of a year, slightly under 400 New Yorkers died each month in 2018 from the flu or pneumonia. […]
Comparatively, if the number of New Yorkers who died as a result of COVID-19 in March was multiplied over the course of a year, the state could see more than 18,000 people die as a result.”

Take the flu season and spread its numbers out over a year to make them seem smaller, then take the worst month of the new outbreak and multiply its victims by 12 to get a really scary number.

Nobody is saying, and I am definitely not, that this pandemic is not a serious problem. It is. But basing policy decisions on fear and ignorance may not be the best idea.

The classic trolley problem is a simple one. Eleven is more than three. It has many variations to complicate the moral question with various value judgments. In the end they all ask us to rank the negative outcomes of our judgments and take moral responsibility for them.

The trolley problem we have to deal with here is the worst kind, because there is no clear way to see what our choices are. We see the sick and the dying on one track while the other track disappears into a big black tunnel. Allowing the trolley to go that way may kill thousands. We just don’t know.
We may understand that everything has a price, but without understanding what that price is, we can hardly be expected to make a rational choice. We cannot evaluate the unseen, so we try to address what we can which is what the media wants us to see. The media and politicians want us to worry so that we will happily delegate our decisions to them.

In a previous post I compared the Covid-19 fatality rates with that of the seasonal influenza. I offered a wager to some friends saying that once this crisis is over, and the tally is final, the total number of the victims will not be higher than the average number of victims of the seasonal flu. The numbers changed since: as of April 2nd, the confirmed cases in the US are at 238,820, the dead at 5,758 compared to 36-51 million cases with 35 thousand dead for the seasonal flu. I may lose my bet, but I would still have to wonder how much this epidemic justifies the harm inflicted in the rest of society by the lock-downs?

What would the trolley problem look like if we started comparing lives lost to jobs lost or bankruptcies declared? Where is the balance between, let’s say 500 jobs lost and the life of an obese chain smoker?
The example is not random. These are both typical pre-existing conditions.
How many will die of causes related to the lock-down? It is easy to count the dead bodies we can see, but how can we count the ones we cannot? How can we calculate the harm caused by the alternatives?

Every decision we make has a cost. Before we make any decision, we should do our best to understand its costs. Four trillion dollars in new debt? On the top of wrecking the economy? While having no idea what we get for it? People are dying as it is. The assumption is that as a result of our actions, fewer will die than would have otherwise. But how cold we possibly know how many?

“A study conducted by Brenner in 1979, found that for every 10 percent increase in the unemployment rate, mortality increased by 1.2 percent, cardiovascular disease by 1.7 percent, cirrhosis of the liver by 1.3 percent, suicides by 1.7%, arrests by 4 percent, and reported assaults by 0.8 percent (see here). How many lost lives out of 300 million in the USA does a 10 percent, 15 percent, 20 percent unemployment rate represent?”

Sweden decided to have limited measures. Their stores and restaurants are open. Their mortality rate as a ratio of confirmed cases is higher than that of the US, but their economy was not harmed. They will not need the equivalent of the US ‘stimulus’ package. They will not drown in debt and they will build herd immunity faster than the Americans. Which, as we know, saves lives.

Politicians see this differently. They want to do something because that is what we expect from them. They don’t know what to do, therefore they do the only thing they how to. They use their power. Political power to the politicians is like a hammer to a child. It makes everything look like a nail, but since not everything is, children with hammers and politicians with power can do a lot of damage.

In the pan(ic)demic trolley problem, the politicians control the switch. What they have is not a moral dilemma but political calculation. They will do whatever gives them more power and a chance for re-election. For you, the only question is this: which track are you tied to?

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3 replies on “The Pan(ic)demic trolley problem”

Your trolley problem illustrates the difficult choices. But I don’t feel panic, and nor do I sense panic in many around me who I’ve been talking with panic. So I don’t perceive the manipulation of “panic” to forfeit my power. At least no more power than I have already forfeited after I casting my ballot, election by election.

Sweden will be an interesting case study to follow. Swedes have a high level of trust in their government, so when the government recommends or asks for social distancing, the population is much more likely to comply than compared to here, and especially compared to the U.S. The U.S. places a high value on individual rights. Hence, historically their slow adoption of mandatory seat belts in cars in the 1960s and 1970s, and to this day several states without motorcycle helmet requirements. Individual rights over public health policies that attempt to reduce the stress on resources.

I chose the expression because I found it funny and catchy, but it also describes the attitude behind the way it is presented to us by the media and the political class. They WANT us to panic. The numbers are inflated, the dangers grossly exaggerated.
There is no stress on resources either. According to this National post article, 78% of ICU beds are empty.
I also have some friends who are quite panicky. I will post as a reply a private exchange to this post to demonstrate.
As for seat belts and motorcycle helmets, …… well, we can talk about them later.

ESM The thing is that since the US doesn’t have enough hospital beds, medical personnel, PPE, & ventilators, it is necessary to order lock-downs. If everybody who has the virus would show up at the same time at the hospitals, violence would break out. Triageing would no longer be possible, because caring for the sickest before the one with less severe symptoms would result in the second one becoming just as sick as the first one. In this scenario, the 222 lbs husband with a gun whose beloved wife is this second person, certainly would not go for the triage-decision. The rich would hire private doctors, hence less would work in the hospitals. Mass death combined with mass violence would not save the economy either. According to the herd immunity model, so many people would die that employee shortage would become the problem. Even in this scenario, when the main breadwinner is gone, the standard of living would go down for the remaining members of the family. Especially, because with an over-abundance of available jobs, employees would have the liberty to lower wages to the level of minimum wage. With lessened purchasing power of the people, there would be less need for certain products & services, hence unemployment would rare its ugly head. Once unemployment is the situation, even less products & services would be needed. So, we are back to the same scene that is happening now. What difference does it make whether it is now or later?

ZGH I guess you missed the point. The lock-down also have a price in human suffering.

ZGH Read the FEE and the Economist article I linked to in the post
You may also want to watch the video I just shared above

ESM I’m pretty sure that most people would chose loneliness over death.

ZGH …. but you do not really believe that. If I am forced to do something, you cannot call that a choice.
If you believed that ‘most people would chose loneliness, you would not have to advocate for coercive restrictions.

ESM For the good of society, society has to make sacrifices. Since a large segment of the population is dumb as a doorknob, advising / forcing folks to sit their asses at home is necessary. I’m certainly not implying that all the elected officials are smart, but for the most part they are. (One great example of a dumb elected official: Trump.)

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